1566例住院2型糖尿病患者心率现状调查

Status survey of rest heart rate of 1566 type 2 diabetes patients in hospital

目的:分析2型糖尿病患者的静息心率和与年龄、糖尿病病程、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、餐后2h血糖(2hPG)、体质指数(BMI)的相关性,及伴高血压、冠心病患者的心率现状和危险因素,为降低心性猝死发病率提供理论依据。方法:采用横断面调查方法对2014-04-2016-03我院住院的2型糖尿病患者按顺序入组,进行病案检索,记录一般情况和心率、糖尿病病程、HbA1c、FPG、2hPG、BMI、合并症及用药情况。共调查2 012例患者,进入分析的2型糖尿病患者1 566例。其中单纯2型糖尿病患者830例,2型糖尿病合并高血压患者588例,2型糖尿病合并冠心病患者46例,2型糖尿病合并高血压和冠心病患者102例,有影响心率因素(起搏器植入、发热、甲亢、应用β受体阻滞剂和非二氢吡啶类钙拮抗剂)、影响血红蛋白因素(贫血、脾亢)、严重肝肾损害疾病患者341例和溯源问题105例均未纳入分析。心率的测量用12导联心电图机以卧位静息为准;HbA1c、FPG、2hPG以空腹静脉血为准,采用葡萄糖氧化酶法,进行生化仪检测;BMI的采集用体重身高测量仪测量身高、体重,用BMI=体重(kg)/身高(cm)~2公式求得。结果:2型糖尿病住院患者的静息平均心率为76.24次/min,主要分布区间在70~79次/min,在单纯2型糖尿病患者中心率≥80次/min者占37.47%,≥90次/min者占14.82%。双变量相关分析显示年龄与心率呈负相关(r=-0.098,P=0.005),HbA1c、FPG和2hPG分别与心率呈正相关(分别为r=0.170,P=0.000;r=0.148,P=0.000;r=0.199,P=0.000),而与糖尿病病程和BMI不相关。HbA1c、FPG、2hPG控制欠佳者心率显著增快。2型糖尿病患者、2型糖尿病伴高血压患者、伴冠心病患者、伴高血压和冠心病患者的静息平均心率分别为(76.42±11.86)、(76.58±11.42)、(77.37±11.08)及(72.28±11.50)次/min。糖尿病合并高血压风险增加与年龄、BMI有关,合并冠心病风险增加与糖尿病病程有关。结论:2型糖尿病患者心率偏快,与长期血糖控制不理想致糖尿病心肌损害有关。因此,HbA1c达标对防治糖尿病心肌损害具有重要意义。

Objective：We analyzed the rest heart rate（RHR）of type 2 diabetes（T2D）and the correlations with age,duration of diabetes,glycosylated hemoglobin（HbA1c）,fasting blood glucose（FPG）,2hour postprandial blood glucose（2hPG）and body mass index（BMI）,as well as the current situation of RHR and risk factors of T2D complicated with hypertension（HT）or coronary heart disease（CHD）,in order to provide the theory basis to decrease the incidence of death related to heart disease.Method：T2D patients hospitalized in the hospital were admitted in order from April in 2014 to March in 2016 using cross-sectional study.Then cases survey was executed and the general conditions,duration of diabetes,HbA1c,FPG,2hPG,BMI,complications and the use of drugs were registered.2012 patients were investigated and 1566 patients were chosen to be analyzed including 830 patients in T2D group（group 1）,588 patients in T2Dcomplicated with HT group（group 2）,46 patients in T2D complicated with CHD group（group 3）and 102 patients in T2D complicated with HT and CHD group（group 4）.The 341 patients were not chosen to be analyzed due to RHR influencing factors（eg.pasemaker implantation,fever,hyperthyroidism,use ofβ-receptor blocker and calcium antagonists（CCBs））and 105 patients due to failing to dating back.Measurement of RHR came from 12 lead electrocardiograph under clinostatism and tranquillization conditions.Measurements of HbA1c,FPG,2hPG came from biochemical analyzer using glucose oxidase method by fasting venous blood.Measurement of BMI came from weight（WT）and height（HT）measuring instrument,which was calculated by formula BMI=WT/HT^2.Result：The mean RHR of T2D patients hospitalized was 76.24 bpm.The main distribution area of RHR was 70~79 bpm.RHR above 80 bpm accounts for 37.47%and RHR above 90 bpm accounts for 14.82%in T2Dgroup.Bivariate correlations display that RHR was negative correlated with age（r=-0.098,P=0.005）,and positive correlated with HbA1c,FPG,2hPG（r=0.17,P=0.000;r=0.148,P=0.000;r=0.199,P=0.000,respectively）,but not correlated with duration of diabetes and BMI.RHR was significantly increased in patients with HbA1c,FPG or 2hPG badly controlled.The mean RHR of group 1,group 2,group 3 and group 4 were（76.42±11.86）,（76.58±11.42）,（77.37±11.08）and（72.28±11.50）bpm,respectively.The increased risks of T2Dcomplicated with HT were correlated with age and BMI,and increased risk of T2D complicated with CHD was correlated with duration of diabetes.Conclusion：The investigation reveals that RHR is increased in T2D patients,and is related to diabetic myocardium impairment due to long-term badly glucose control.Hence,it is of great significance for HbA1c to reach the standard to prevent and cure diabetic myocardium impairment.